Original Article |

Recurrent Contact Granuloma:  Experience With Excision and Botulinum Toxin Injection

Taner Yılmaz, MD; Nilda Süslü, MD; Gamze Atay, MD; Serdar Özer, MD; Rıza Önder Günaydın, MD; Münir Demir Bajin, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(6):579-583. doi:10.1001/jamaoto.2013.3186.
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Importance Contact granuloma is a difficult-to-treat laryngeal disorder associated with vocal abuse, habitual throat clearing, and laryngopharyngeal reflux. It has a high propensity for persistence and recurrence despite many treatment alternatives.

Objective To present our experience with recurrent contact granuloma treated with microlaryngoscopic excision and botulinum toxin injection.

Design Case series. The follow-up period had a mean (range) of 41 (11-88) months.

Setting Tertiary referral university clinic.

Participants Twenty patients with recurrent, grade 3 and grade 4 contact granuloma whose lesion was excised at least once after failure of conservative treatments.

Interventions Microlaryngoscopic excision and botulinum toxin type A injection into the region of the bilateral thyroarytenoid and lateral cricoarytenoid muscles.

Main Outcomes and Measures Disappearance of contact granuloma.

Results Seventeen patients were cured of their contact granuloma. Three patients experienced recurrences: 2 received botulinum toxin injection only as outpatients and recovered. The other patient required reexcision and reinjection under general anesthesia. These 3 patients were free of granuloma at their last follow-up.

Conclusions and Relevance After failed conservative treatment, microlaryngoscopic excision and botulinum toxin type A injection is successful in the treatment of recurrent contact granuloma. Removing recurrent granulomas can result in a low recurrence rate if botulinum toxin type A is added at the time of removal.

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Figure 1. Botulinum toxin A injection sites within the larynx. A, Thyroarytenoid muscle; B, lateral cricoarytenoid muscle; C, interarytenoid muscle; D, aryepiglottic muscle.

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Figure 2. Images of patient 4. A, Right-sided grade 4 lesion; B, after follow-up of more than 7 years.




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